HEALTH CARE REFORM

Potential Negative Impact of AHCA on Genetic Testing

While it remains uncertain what the Senate will do with the American Health Care Act (AHCA), alarm is spreading about the legislation’s implications for the estimated quarter of Americans under the age of 65 years (more than 50 million people) that have a preexisting condition. One of the more popular features of the Affordable Care Act (ACA) was its guarantee that insurance companies could not deny coverage to people with preexisting conditions. Prior to 2014, when the ACA took effect, private insurers evaluated the health status, health history, and risk factors of applicants for coverage and premium decisions.

Concern is mounting over the AHCA’s provision that allows states to apply for waivers that could allow insurers to charge those with preexisting conditions substantially more, possibly pricing them out of the market to buy individual health insurance.

In just the last few years, genetic testing, including tests that assess hereditary cancer risk, has expanded dramatically. While this has been viewed as a positive development, empowering patients to proactively manage potential health conditions by personalizing screening strategies, the information now may be perceived as liability if the AHCA reverses the ban on preexisting conditions.

According to research from the Kaiser Family Foundation, the preexisting condition exclusion clauses varied state by state prior to the ACA.

  • In 19 states, a health condition was considered preexisting only if the individual had actually received treatment or medical advice for the condition during defined period of time prior to the coverage effective date.
  • In most states, a preexisting condition could also include one that had not been diagnosed, but that produced signs or symptoms that would prompt most people to seek medical advice or treatment.
  • However, in eight states and Washington, D.C., conditions that existed prior to the coverage effective date— including those that were undiagnosed and asymptomatic—could be considered preexisting and excludable from coverage under an individual market policy.

Previously declinable preexisting conditions in the individual market included: infectious diseases (AIDS/HIV, Hepatitis C virus), cancer, and many common diseases that researchers are examining for an underlying genetic cause (heart conditions, diabetes, Alzheimer’s, Parkinson’s disease, and mental disorders).

While it remains to be seen what will happen regarding preexisting conditions, and whether undiagnosed, asymptomatic conditions will be considered preexisting, there is mounting speculation of how this provision of the AHCA will impact adoption of genetic testing. Presumably the nascent market of preemptive wellness sequencing could be impacted, as could familial genetic testing and even direct-to-consumer genetic testing.

Takeaway: While it remains uncertain what final form AHCA legislation will take, there are increasing concerns over the definition of preexisting conditions in the era of genomic medicine.

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